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Top 20 Healthiest Cities In America 2014

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It's official: Washington D.C. is the healthiest city in America. That's big news for the Capitol, and for Minneapolis-St. Paul, which got demoted to #2 after holding the top spot for three straight years.

But what makes one city a healthy place to live, and another the opposite? That's what's really interesting about the American College of Sports Medicine (ACSM)’s much-anticipated 2014 report ranking the healthiest metropolitan areas in America.

Where is your city ranked? Read on to find out.

Officially termed the American Fitness Index (AFI), the ranking assesses the “Health and Community Fitness Status of the 50 Largest Metropolitan Areas.” It's a data-crunching behemoth, using a very specific series of measures that get down to the nitty-gritty of how well a city serves the recreational health and fitness needs of its residents. (For an alternative reality check, see America's 10 Laziest Cities for the cities with the lowest overall activity levels.)

Since my prior report on the Top 20 Healthiest Cities, the AFI has changed some of the factors that go into making its calculations. This year, for example, a new variable was added called the Walk Score, while other variables were removed. This makes it harder to make direct comparisons.

Nevertheless, some important factors matter year after year; for example, all five of the healthiest cities boasted obesity rates under 23 percent and smoking rates under 18 percent. (Just 10 percent for San Francisco and 13 percent for D.C.)

And as a snapshot of success, 81 percent of people in Washington D.C. did some kind of physical activity in the last 30 days and fewer than 22 percent are obese. Residents’ rates of heart disease, diabetes, asthma, and general health are also important.

But what sets the AFI ranking apart from other national metrics that track personal health behaviors is the scoring based on community and environmental indicators.

“The AFI data report is a snapshot of the state of health in the community and an evaluation of the infrastructure, community assets and policies that encourage healthy and fit lifestyles," said Walter Thompson, chair of the AFI's advisory board.

So there you have it: The key to who wins and who loses in this particular competition is infrastructure. The AFI’s mission is to encourage cities to prioritize the health of their residents and spend and make improvements accordingly. So a city that just happens to have lots of gym-going, veggie-eating residents (think New York) is not necessarily going to rate, because the city’s culture and politics are not at work supporting residents in making health and lifestyle changes.

As just one example of this, let’s look at parks. First place winner Washington spends $398 per resident on its parks as compared with Memphis, last ranked at #50, which spends just $26 per resident.

To wit, said Thomas:  “Health advocates and community leaders have come to expect the arrival of the American Fitness Index as an annual check-up regarding their community’s health and fitness levels.” In other words, Memphis, build some parks and recreational centers.

Who Won, Who Lost, in 2014?

New to the top 10 is San Diego, which is ranked the 8th healthiest city, up from 14th last year. Gone from the top 10 is Hartford, last year 9th on the list, now down to 12th. But the majority of the cities on the list have been there before, some simply swapping places with a rival. Since 2013 Boston dropped from 6th to 9th place, Denver dropped one spot from 4th to 5th. San Jose rose from 10th to 6th.

One thing is clear; the west is winning the healthy lifestyle war. With the addition of San Diego, 6 of the top 10 cities are now on the West Coast. The Midwest boasts just one city in the top 10, the south not one.

In fact, the south, in what really should constitute a call for national action, boasts just one city, the culturally anomalous Austin, Texas, in the top 20. And 17 of the 20 least healthy cities (unfortunate exceptions being Indianapolis, Detroit, and Columbus, Ohio) are in the South.

Here are America's Top 10 Healthiest Cities with their AFI Ranking Scores:

  1. Washington, D.C. 77.3
  2. Minneapolis-St. Paul, Minn. 73.5
  3. Portland, Oregon. 72.1
  4. Denver, Colorado. 71.7
  5. San Francisco, Calif. 71.0
  6. San Jose, Calif. 69.4
  7. Seattle, Wash. 69.3
  8. San Diego, Calif. 69.2
  9. Boston, Mass. 69.1
  10. Sacramento, Calif. 66.9

So which factors made a difference in helping a city improve its score? San Diego, which is new to the top -10 list at number 8, jumping from 14th place last year, offers some insight. In San Diego, 77 percent of residents engaged in physical activity in the last 30 days and just 23 percent are obese, giving the city a fourth-place ranking in the individual health behaviors category.

Almost 40 percent of San Diegans eat at least two servings of fruit a day and 20 percent eat three or more servings of vegetables a day, well above the national average.

However, the city ranked 14th in community health indicators, most startlingly in that less than 3 percent of residents use public transportation to get to work and less than 4 percent walk or bicycle to work. Nevertheless, the city’s walk score was just a hair shy of 50 percent.

And Here Are the Cities Ranked 10 to 20:

  1. Salt Lake City, Utah 65.7
  2. Hartford, Conn. 63.8
  3. Raleigh, N.C. 61.5
  4. Austin, Texas 60.6
  5. Chicago, Ill. 56.6
  6. Atlanta, Ga. 56.0
  7. Pittsburgh, Pa. 54.8
  8. Cincinnati, Ohio 54.5
  9. Los Angeles, Calif. 53.4
  10. Philadelphia, Pa. 52.9

New to the top 20 for 2014 are Atlanta, Philadelphia, and Los Angeles, which displaced Cleveland, Baltimore and Virginia Beach. The annual investigation and report is funded by a $158,000 grant from the Wellpoint Foundation.

For more health news, follow me here on Forbes.com, on Twitter, @MelanieHaiken,and subscribe to my posts on Facebook.